PROJECT SUMMARY Asthma is the most prevalent childhood chronic illness, affecting 9.7% of adolescents. National guidelines emphasize the importance of adherence to self-management behaviors for controlling asthma and preventing impaired health and quality of life. Adolescents have suboptimal adherence to asthma self-management behaviors, placing them at risk for morbidity and reduced quality of life. Asthma self-management difficulties emerge in early adolescence as youth begin to transition towards taking more control of their treatment regimen, making it a critical intervention period. The presence of helpful caregiver support is pivotal in determining whether early adolescents ultimately develop and master asthma self-management behaviors. Our interdisciplinary team received NIH funding (PI: Fedele; R21 HD083830) to respond to the critical need for the development of an intervention to facilitate helpful caregiver support in early adolescents (12-15 year-olds) with poorly controlled asthma. AIM2ACT is a dyadic smartphone intervention, informed by the Pediatric Self- Management Model that is specifically tailored to increase helpful caregiver support and adolescent asthma self-efficacy, thereby improving asthma control. AIM2ACT contains three components: 1) ecological momentary assessment to identify personalized strengths and weaknesses in asthma self-management behaviors; 2) collaborative identification and tracking of goals that help early adolescents to become increasingly independent in managing their asthma; and 3) a suite of engaging skills training videos to help dyads understand how to use AIM2ACT and work together to set asthma self-management goals, develop and achieve goals, and engage in problem-solving communication. Results of our pilot trial revealed high feasibility and acceptability of our protocol and preliminary efficacy for AIM2ACT in improving asthma control. The proposed study will test the efficacy of AIM2ACT and long-term maintenance of treatment effects in a fully- powered randomized controlled trial with 160 early adolescents with poorly controlled persistent asthma, ages 12-15 years, and a caregiver. Families will be randomly assigned to receive AIM2ACT (n=80) or a mHealth attention control condition (n=80) that accounts for staff attention and novelty of a technology-based intervention for 6 months. Dyads in the control condition will not receive personalized asthma management feedback, will not be guided through collaborative identification and tracking of asthma self-management goals, and will not have access to skills training videos. Instead, they will receive static educational information on their smartphones about behavioral management techniques they can use to target improving asthma self- management. The control condition is designed to optimize recruitment and sustain interest while concurrently having a minimal impact on asthma management. Assessments will occur at baseline, post-intervention, and 3-, 6-, and 12-month follow-up time points. Patient-reported (e.g., Asthma Control Test) and objectively monitored (e.g., spirometry, medication adherence) outcomes will be collected.